Entry guide for multiple instruments in a single port surgical system

ABSTRACT

An access port for use in single port surgery includes a cannula to provide minimally invasive access to a surgical site and an instrument guide that fits closely within the cannula. The instrument guide includes guide channels that are open to the outside surface of the instrument guide. Each of the guide channels is configured to support a single surgical instrument at a defined position within the cannula. The guide channels may be smoothly enlarged at the end that receives surgical instruments. The access port may further include a seal that couples the instrument guide to the cannula such that the seal retains a pressurized insufflation fluid within the surgical site. The instrument guide may include one or more insufflation channels for introducing an insufflation fluid to the surgical site. The access port may include a flexible section. The surgical instruments may be controlled robotically by servo actuators.

BACKGROUND

Field

This invention relates to surgical cannulas, and more particularly, to asurgical cannula for introducing multiple minimally invasive surgicalinstruments through a single opening in the body.

Background

Minimally invasive surgery (MIS) (e.g., endoscopy, laparoscopy,thoracoscopy, cystoscopy, and the like) allows a patient to be operatedupon through small incisions by using a camera and elongated surgicalinstruments introduced to an internal surgical site. The surgical siteoften comprises a body cavity, such as the patient's abdomen. The bodycavity may optionally be distended using a clear fluid such as aninsufflation gas. In traditional minimally invasive surgery, the surgeonmanipulates the tissues by using hand-actuated end effectors of theelongated surgical instruments while viewing the surgical site on avideo monitor.

One or more cannulas may be passed through small (generally 1 inch orless) incisions or a natural body orifice to provide entry ports for theminimally invasive (e.g., endoscopic, laparoscopic, and the like)surgical instruments, including a camera instrument (e.g., endoscope,laparoscope, and the like). A surgeon is able to perform surgery bymanipulating the surgical instruments externally to the surgical siteunder the view provided by the camera instrument.

It is typical to provide several cannulas for a minimally invasivesurgical procedure. Generally each cannula will provide access to thesurgical site for a single surgical or camera instrument. For example,four cannulas may be provided with one cannula being used to introduce acamera instrument and the remaining three cannulas being used tointroduce surgical instruments. While the small incisions necessary forplacing a cannula are less traumatic than the incision necessary foropen surgery, each incision still represents a trauma to the patient.

In an effort to reduce the trauma of minimally invasive surgery evenfurther, techniques are being developed to allow minimally invasivesurgery using only a single cannula. This may be accomplished by using asomewhat larger cannula that can accommodate all of the instrumentsrequired for the surgery. Minimally invasive surgery performed through asingle cannula may be referred to as single port access (SPA) surgery.The single cannula may be introduced through a body orifice and bereferred to as Natural Orifice Transdermal Endoscopic Surgery (NOTES).Single port surgery may also be referred to as bellybutton surgery whenthe navel (umbilicus) is used as the location for the single cannula.

If multiple surgical instruments and/or camera instruments are to beintroduced to a surgical site through a single cannula, it can becomedifficult manage the instruments within the cannula. It is desirable touse as small a cannula as possible consistent with the size of theinstruments to be passed through the cannula. This may make it difficultto introduce the additional instruments and to maintain the necessarymobility of the instruments.

These difficulties may be even greater for robotically controlledminimally invasive surgical procedures because of the roboticcontrollers on the instruments. The robotic controllers may limit thevisibility and accessibility of the cannula. The robotic controllers mayrender the instruments less agile with regard to introduction into thecannula.

In view of the above, it would be desirable to provide an improvedcannula for carrying out minimally invasive surgical procedures thatfacilitates the introduction of multiple surgical instruments and/orcamera instruments to a surgical site through a single compact cannula.

SUMMARY

An access port for use in single port surgery includes a cannula toprovide minimally invasive access to a surgical site and an instrumentguide that fits closely within the cannula. The instrument guideincludes guide channels that are open to the outside surface of theinstrument guide. Each of the guide channels is configured to support asingle surgical instrument at a defined position within the cannula. Theguide channels may be smoothly enlarged at the end that receivessurgical instruments. The access port may further include a seal thatcouples the instrument guide to the cannula such that the seal retains apressurized insufflation fluid within the surgical site. The instrumentguide may include one or more insufflation channels for introducing aninsufflation fluid to the surgical site. The access port may include aflexible section. The surgical instruments may be controlled roboticallyby servo actuators.

Other features and advantages of the present invention will be apparentfrom the accompanying drawings and from the detailed description thatfollows below.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention may best be understood by referring to the followingdescription and accompanying drawings that are used to illustrateembodiments of the invention by way of example and not limitation. Inthe drawings, in which like reference numerals indicate similarelements:

FIG. 1 is a perspective view of a master control workstation and amanipulator system for robotically moving a plurality of minimallyinvasive surgical instruments.

FIG. 2 is a pictorial view of an access port.

FIG. 3 is a pictorial view of an instrument guide.

FIG. 4 is a bottom elevation of the access port.

FIG. 5 is a cross-section of the access port along the line 4-4 in FIG.3.

FIG. 6 is a top elevation of the access port.

FIG. 7 is a cross-section of the access port along the line 7-7 in FIG.6.

FIG. 8 is a bottom elevation of another access port.

FIG. 9 is a cross-section of the access port along the line 9-9 in FIG.8.

FIG. 10 is a side elevation of another instrument guide.

FIG. 11 is a side elevation of another access port.

FIG. 12 is a top elevation of the access port of FIG. 11.

FIG. 13 is a cross-section of the access port along the line 13-13 inFIG. 12.

FIG. 14 is an elevation of the bottom end of the access port of FIG. 12.

FIG. 15 is a bottom elevation of another access port.

FIG. 16 is a cross-section of the access port along the line 16-16 inFIG. 15.

DETAILED DESCRIPTION

In the following description, numerous specific details are set forth.However, it is understood that embodiments of the invention may bepracticed without these specific details. In other instances, well-knowndevices, structures and techniques have not been shown in detail inorder not to obscure the understanding of this description.

FIG. 1 shows a pictorial view of a minimally invasive surgery on apatient 10 using single port access 12 for robotic surgical instruments402, 404, 406. Typically three or four surgical instruments, including acamera instrument, are introduced through the access port 12. Inaddition, there will generally be provisions for introducing aninsufflation gas, such as carbon dioxide (CO₂), at or near the accessport. It will be appreciated that single port surgery requires asubstantial amount of equipment to be located in a small amount ofspace.

The robotic surgical instruments 402, 404, 406, which may include acamera instrument that may provide images of the surgical site and otherinstruments, are coupled to actuators 22, 24, 26, 28, such as servoactuators that allow a surgeon to manipulate the surgical instrumentsusing a computer mediated control station 20 (FIG. 1). Thesemanipulations may include functions such as positioning, grasping, andmoving. Such actuator control of surgical instruments may be referred toas robotic surgery.

A control system couples a computer mediated control station 20 to therobotic actuators 22, 24, 26, 28. As described in more detail in U.S.Pat. No. 6,424,885 entitled “Camera Referenced Control In A MinimallyInvasive Surgical Apparatus,” the full disclosure of which incorporatedherein by reference, the control system will preferably coordinatemovement of the input devices with the movement of their associatedsurgical instruments so that the images of the surgical instruments 402,404, 406, as displayed to the surgeon, appear at least substantiallyconnected to the input devices in the hands of the surgeon. Furtherlevels of connection will also often be provided to enhance thesurgeon's dexterity and ease of use of the surgical instruments 402,404, 406.

The computer mediated control station 20 may provide hand operatedcontrollers 30 that allow manipulation of the robotic surgicalinstruments 402, 404, 406 by transmitting signals, such as electricalcontrol signals provided by cables 32, to the actuators 22, 24, 26, 28that control the actions of the coupled surgical instruments 402, 404,406. Typically one of the surgical instruments 402 will be a camerainstrument that is manipulated to place the remaining surgicalinstruments and the objects being manipulated within a field of view ofthe camera. The camera instrument transmits signals to the controlstation 20 so that an image captured by the camera of the instrumentsand objects within the field of view can be displayed on a visualdisplay 34 that viewed by the surgeon as the coupled surgicalinstruments 404, 406 are manipulated. The hand operated controllers 28and the visual display 30 may be arranged to provide an intuitivecontrol of the surgical instruments 404, 406, wherein the instrumentsrespond in an expected manner to movements of the controllers.

FIG. 2 shows a pictorial view of an access port that provides the singleport access shown in FIG. 1. The access port includes a cannula 100 andan instrument guide 200 that is inserted into the cannula to guidemultiple instruments through the cannula to facilitate single portaccess. It is desirable to minimize the diameter of the cannula 100 sothat the incision necessary for placing the cannula in a patient islikewise minimized. The outer wall of the lower portion of the cannula100 supports and distends the tissues around the incision to providesurgical access while protecting the tissues from injury due to thenecessary movements of the surgical instruments.

FIG. 3 is a pictorial view of the instrument guide 200. The instrumentguide 200 is configured to fit closely within the cannula 100. Theinstrument guide 200 includes a number of guide channels 222, 224. Eachof the guide channels 222, 224 is configured to support a singlesurgical instrument 402, 404, 406 at a defined position within thecannula 100. The surgical instruments 402, 404, 406 are inserted intothe access port through openings 202, 204, 206, 208 at a proximal end ofthe instrument guide 200. The surgical instruments 402, 404, 406 aresupported by the guide channels 222, 224 until they emerge from a distalend 232, 234 of the instrument guide 200. The instrument guide may beformed from an electrically non-conductive material to aid inelectrically isolating the instruments which may carry an electricalcharge used for cauterization.

FIG. 4 is a bottom elevation of the access port. Each of the guidechannels is open to the outside surface of the instrument guide. Thisplaces a portion of the inserted surgical instruments 402, 404, 406, 408immediately adjacent the inner wall of the cannula 100 which allows thediameter of the cannula to be minimized. Interstitial portions 230 ofthe instrument guide 200 support and locate the guide within the cannula100. The generally cylindrical shape of the instrument guide 200 allowsthe guide and the inserted surgical instruments to be rotated within thecannula 100.

FIG. 5 is a cross-section of the access port along the line 5-5 in FIG.4. The proximal end 102 of the cannula 100 has a larger diameter thanthe distal end 104. The proximal end of the cannula 100 is tapered to acylindrical lower end having the distal diameter. The cylindrical lowerend is the portion of the cannula 100 that is inserted into theincision. The cannula is inserted into the incision and then theinstrument guide 200 is inserted into the cannula. The enlarged proximalend 102 and tapered section of the cannula 100 may aid insertion of theinstrument guide 200.

The proximal end 210 of the instrument guide 200 is sized and shaped toclosely fit the proximal end of the cannula 100. The instrument guide200 may include a seal 210, such as an O-ring, that couples theinstrument guide to the cannula 100 such that the seal retains apressurized insufflation fluid within the surgical site. The seal 210may further provide a retention force so that the instrument guide isnot lifted from the cannula by the pressure of the insufflation fluidwithin the surgical site. The guide channels 224, 226, 228 are open tothe cannula in the cylindrical lower end and then become closed in theupper proximal end 210. The closed portion of the guide channels 224,226, 228 may closely fit the surgical instruments 402, 404, 406, 408 tominimize the loss of insufflation fluid past the instruments in theaccess port. The guide channels 224, 226, 228 may include a seal thatminimizes the loss of insufflation fluid when an instrument is notpresent in the guide channel.

FIG. 6 is a top elevation of the access port. The enlarged portions 202,204, 206, 208 of the guide channels 212, 214, 216, 218 at the proximal(top) end 210 may be seen.

FIG. 7 is a cross-section of the access port along the line 7-7 in FIG.6. This view shows the guide channels 224, 228 being smoothly enlarged204, 208 as the channels approaches the proximal end 210 of theinstrument guide 200. The enlarged openings and tapered sections mayhelp position instruments within the access port.

FIG. 8 is a bottom elevation of yet another access port. FIG. 9 is across-section of the access port along the line 9-9 in FIG. 8. In thisembodiment, the cannula 800 includes an insufflation port to receive aninsufflation fluid. It will be appreciated that the insufflation port isshown in a simplified form and that the insufflation port may includevalve and fittings as may be required to connect a source ofinsufflation fluid and control its flow.

As best seen in the bottom elevation of FIG. 8, the embodiment of theinstrument guide 900 shown includes at least one insufflation channel931, 933, 935, 937. Referring to FIG. 9, each insufflation channel 925,927 is located between two adjacent guide channels, 924, 926, 928, openat the distal end 935, 937, closed at the proximal end 915, 917, andopen along at least a portion of a length of the guide adjacent theproximal end, such that an insufflation fluid introduced into thecannula 800 through the insufflation port 806 flows through theinsufflation channel to the surgical site and is retained within theinsufflation channel at the proximal end. In another embodiment, theinsufflation fluid introduced into the cannula 800 through theinsufflation port 806 flows to the surgical site through the clearancebetween the cannula and the instrument guide without the use of aninsufflation channel.

FIG. 10 is a side view of another instrument guide 1000 for use inminimally invasive surgery that includes a flexible section 1004 at adistal end 1006. This instrument guide 1000 would be used with aflexible surgical instrument having a flexible shaft that conforms tothe curve of the instrument guide as the instrument is passed from theproximal end 1002 to the distal end 1006 through the guide channel 1008.In some embodiments, the flexible section 1004 may be adjustable suchthat the amount and direction of the curvature can be adjusted, such asby pulling on guide cables 1010, 1012.

FIG. 11 is a side view of an access port for use in minimally invasivesurgery that includes the instrument guide 1000 with the flexiblesection and a cannula 1100 with a curved section 1104 extending thecannula lumen 1102. In some embodiments, the curved section 1104 of thecannula 1100 may be a fixed curve to which the flexible section 1004 ofthe instrument guide 1000 conforms as it is inserted into the cannula.In such embodiments, the guide cables 1010, 1012 may be omitted.

FIG. 12 is a top elevation of the access port of FIG. 11. Guide cables1010, 1012, 1014, 1016 may emerge from the proximal end 1002 to berouted to a backend mechanism. The guide cables may be routed throughbores in the instrument guide 1000. The lower end 1104 of the cannula1100 may be flexible so that the amount and direction of the curvaturecan be conform to the curvature of the instrument guide 1000. In oneembodiment the backend mechanism may lock the flexible section 1004 ofthe instrument guide 1000 in a desired curvature and orientation. Inanother embodiment the backend mechanism may include robotic actuatorsthat allow robotic control of the shape and orientation of the flexiblesection 1004 of the instrument guide 1000. In still other embodiments,the cannula may contain the mechanism for adjusting the amount anddirection of the curvature and the instrument guide may conform to thecannula.

FIG. 13 is cross-section view taken along a line corresponding to theline 13-13 in FIG. 12 showing a construction for the flexible section1104. The flexible section may include jointed links 1122, 1124, 1126.Cables 1010, 1012 may control the curvature of the inserted instrumentguide 1000 and thereby steer and/or lock the jointed links of thecannula 1100. It will be appreciated that if jointed links are used toconstruct an articulated flexible section 1104 in the cannula 1100, aconforming cover (not shown) may be provided to provide a smooth curvedsurface on the exterior and/or interior of the cannula.

FIG. 14 is a plan view of the distal end 1106 of the cannula 1100 andthe distal end 1006 of the inserted instrument guide 1000. If guidecables 1010, 1012, 1014, 1016 are provided, they may pass through boresin the instrument guide 1000 and be coupled to the distal end 1006, suchas by balls crimped onto the ends of the guide cables that engagerecesses at the distal end of the bores. In other embodiments, the guidecables may pass through the sidewall of the tubular portion 1102 of thecannula 1100.

FIG. 15 is a bottom elevation of another access port. FIG. 16 is across-section of the access port along the line 16-16 in FIG. 15. Theproximal end 1502 of the cannula 1500 has a larger diameter than thedistal end 1504. The proximal end 1502 of the cannula 1500 is tapered toa cylindrical lower end 1508 having the distal diameter. The cylindricallower end 1508 is the portion of the cannula 1500 that is inserted intothe incision. The cannula 1500 is inserted into the incision and thenthe instrument guide 1510 is inserted into the cannula. The enlargedproximal end 1502 and tapered section of the cannula 1500 may aidinsertion of the instrument guide 1510.

The proximal end 1512 of the instrument guide 1510 is sized and shapedto fit the proximal end 1502 of the cannula 1500. In the embodimentshown, the proximal end 1512 of the instrument guide 1510 includes acylindrical portion 1516 that fits within a corresponding cylindricalportion 1506 of the cannula 1500. The instrument guide 1510 includes aseal 1514, such as an O-ring, that couples the instrument guide to thecylindrical portion 1506 of the cannula 1500 such that the seal retainsa pressurized insufflation fluid within the surgical site.

The guide channels 1524, 1526, 1528 of the instrument guide 1510 areopen to the cannula 1500 in the cylindrical lower end 1508 of thecannula and then become closed in the upper proximal end 1512. Theclosed portion of the guide channels 1524, 1526, 1528 may closely fitthe surgical instruments to minimize the loss of insufflation fluid pastthe instruments in the access port. In particular, the guide channels1524, 1526, 1528 are closed in the cylindrical portion 1516 of theinstrument guide 1510 that is above the seal 1514.

The seal 1514 is located on the distal end of the cylindrical portion1516 so that the instrument guide 1510 seals against the cannula 1500when the distal end of the cylindrical portion of the instrument guideis at the proximal end of the corresponding cylindrical portion 1506 ofthe cannula 1500. This permits the instrument guide 1510 to be raisedand lowered within the cannula 1500 to facilitate placement of thesurgical instruments adjacent the surgical site. In other embodiments,the seal is located at the proximal end of the cylindrical portion 1506of the cannula 1500.

In the embodiment shown, the lower portion 1518 of the instrument guide1510 has a length that is sufficient to at least reach the distal end1504 of the cannula 1500 when the seal 1514 is at the proximal end ofthe cylindrical portion 1506 of the cannula. Thus the distal end 1520 ofthe instrument guide 1510 will extend substantially beyond the distalend 1504 of the cannula 1500 when the instrument guide is fully insertedinto the cannula. In other embodiments, the instrument guide does notreach the distal end of the cannula in some or all operative positions.The open portion of the guide channels 1524, 1526, 1528 in the lowerportion of the instrument guide 1510 surround the surgical instrumentssufficiently to provide lateral support of the instruments in theportion of the guide that extends beyond the distal end 1504 of thecannula 1500.

While certain exemplary embodiments have been described and shown in theaccompanying drawings, it is to be understood that such embodiments aremerely illustrative of and not restrictive on the broad invention, andthat this invention is not limited to the specific constructions andarrangements shown and described, since various other modifications mayoccur to those of ordinary skill in the art. The description is thus tobe regarded as illustrative instead of limiting.

What is claimed is:
 1. An access port for use in single port surgery,the access port comprising: a cannula used to provide minimally invasiveaccess to a surgical site, the cannula having a first opening at aproximal end, a second opening at a distal end, and an inner wallsurface between the first opening and the second opening; and aninstrument guide having an outside surface that fits closely to theinner wall surface of the cannula, the instrument guide including aproximal end that fits within the first opening of the cannula andreceives a plurality of surgical instruments that pass through the firstopening of the cannula, a distal end that fits within the second openingof the cannula and through which the plurality of surgical instrumentsemerge and pass through the second opening of the cannula, and aplurality of guide channels, each of the plurality of guide channelsbeing configured to support a corresponding single surgical instrumentof the plurality of surgical instruments at one of a correspondingplurality of defined positions within the cannula, each of the pluralityof guide channels being open to the outside surface of the instrumentguide to place a portion of the corresponding single surgical instrumentsupported by each guide channel immediately adjacent the inner wallsurface of the cannula.
 2. The access port of claim 1 further comprisinga seal that seals to the instrument guide and to the cannula such thatthe seal retains a pressurized insufflation fluid within the surgicalsite.
 3. The access port of claim 1 wherein the instrument guideincludes a proximal end that receives surgical instruments and anopposing distal end where the surgical instruments emerge, theinstrument guide further comprising at least one insufflation channel,the insufflation channel being between two adjacent guide channels, openat the distal end, closed at the proximal end, and open along at least aportion of a length of the guide adjacent the proximal end, such that aninsufflation fluid introduced into the cannula flows through theinsufflation channel to the surgical site and is retained within theinsufflation channel at the proximal end.
 4. The access port of claim 1wherein the instrument guide includes a proximal end that receivessurgical instruments and an opposing distal end where the surgicalinstruments emerge, the proximal end being larger than the distal end,each of the guide channels being smoothly enlarged as each of the guidechannels approaches the proximal end.
 5. The access port of claim 1wherein the instrument guide is formed from an electricallynon-conductive material.
 6. The access port of claim 1 wherein theinstrument guide includes a flexible section to fit within acorresponding flexible section of the cannula.
 7. The access port ofclaim 6 further comprising a plurality of cable channels and a likeplurality of cables for locking the flexible sections in a curvedconfiguration.
 8. The access port of claim 6 further comprising aplurality of cable channels and a like plurality of cables to beconnected to a robotic controller for controlling a curvature of theflexible sections of the cannula and the instrument guide.
 9. A roboticsystem for use in minimally invasive surgery, the system comprising: asurgical instrument including an end effector; a first actuator coupledto the surgical instrument to control the end effector; a camerainstrument; a second actuator coupled to the camera instrument tocontrol the camera instrument; a cannula used to provide minimallyinvasive access to a surgical site, the cannula having a first openingat a proximal end, a second opening at a distal end, and an inner wallsurface between the first opening and the second opening; and aninstrument guide having an outside surface that fits closely to theinner wall surface of the cannula, the instrument guide including aproximal end that fits within the first opening of the cannula andreceives the instruments through the first opening of the cannula, adistal end where the instruments emerge, emerge through the secondopening of the cannula, and a plurality of guide channels, one of theplurality of guide channels being configured to support the surgicalinstrument at a first defined position within the cannula and another ofthe plurality of guide channels being configured to support the camerainstrument at a second defined position within the cannula, each of theplurality of guide channels being open to the outside surface of theinstrument guide to place a portion of each of the instruments supportedby the guide channels immediately adjacent the inner wall surface of thecannula.
 10. The robotic system of claim 9 wherein the first actuator isa servo controlled actuator.
 11. The robotic system of claim 9 whereinthe second actuator is a servo controlled actuator.
 12. The roboticsystem of claim 9 further comprising a video display for displaying animage captured by the camera of a transfer of an object.
 13. The roboticsystem of claim 9 wherein the cannula includes a flexible section. 14.The robotic system of claim 13 wherein the flexible section can belocked in a curved configuration by means of cable routed through theinstrument guide.
 15. The robotic system of claim 13 wherein theflexible section can be robotically controlled to achieve a desiredcurved configuration.
 16. The robotic system of claim 9 wherein thesurgical instrument is flexible.
 17. The robotic system of claim 9wherein the camera instrument is flexible.
 18. An access port for use insingle port surgery, the access port comprising: means for providingminimally invasive access to a surgical site through a single incision,the means for providing access having a first opening at a proximal end,a second opening at a distal end, and an inner wall surface between thefirst opening and the second opening; and means for supporting aplurality of surgical instruments, each of the plurality of surgicalinstruments being supported at a corresponding one of a like pluralityof defined positions within the means for providing access, the meansfor supporting including a proximal end that receives the plurality ofsurgical instruments that pass through the first opening of the meansfor providing access, a distal end through which the plurality ofsurgical instruments emerge and pass through the second opening of themeans for providing access, an outside surface immediately adjacent theinner wall surface of the means for providing access, and openings inthe outside surface such that a portion of each of the surgicalinstruments supported by each guide channel is immediately adjacent theinner wall surface of the means for providing access.
 19. The accessport of claim 18 further comprising means for retaining a pressurizedinsufflation fluid within the surgical site.
 20. The access port ofclaim 18 further comprising means for introducing a pressurizedinsufflation fluid to the surgical site.
 21. A method for minimallyinvasive surgery using a single access port, the method comprisingsupporting a plurality of surgical instruments at a like plurality ofdefined positions within an instrument guide inserted into a singlecannula, the instrument guide having an outside surface that fitsclosely within an inner wall of the cannula, the instrument guideincluding a proximal end that receives surgical instruments, a distalend where the surgical instruments emerge, and a plurality of guidechannels, each of the plurality of guide channels configured to supporta single surgical instrument at one of the like plurality of definedpositions within the cannula, each of the plurality of guide channelsbeing open to the outside surface of the instrument guide to place aportion of each of the surgical instruments immediately adjacent theinner wall of the cannula.
 22. The method of claim 21 further comprisingcoupling the instrument guide to the cannula with a seal such that theseal retains a pressurized insufflation fluid within the surgical site.